Look to Norway: Serving new families and infants in a multiethnic population

Despite recognition that immigrant women face significant health challenges, addressing the healthcare needs of immigrants is a source of debate in the United States. Lack of adequate healthcare for immigrants is recognized as a social justice issue, and other countries have incorporated immigrants into their healthcare services. Oslo, the fastest growing capital in Europe, is rapidly shifting to a heterogeneous society prompting organizational action and change. The New Families Program serves first-time mothers and their infants in an Oslo district serving 53% minorities from 142 countries. Anchored in salutogenic theory, the program aims to support the parent–child relationship, children's development and social adaptation, and to prevent stress-related outcomes. Formative research has informed the successful program development and implementation within the existing maternal and child healthcare service. Implications for addressing maternal and child health needs of an immigrant population are presented.     

CBT with Youth: Immodest Proposals for Training the Next Generation

January 2014 brings the inauguration of the Affordable Care Act (ACA) in the United States. The ACA introduces affordable healthcare to all citizens and proposes a system to hold all healthcare providers accountable for quality treatment. This article discusses differences in the new healthcare climate and highlights specific areas of focus for training child clinicians in CBT in the midst of this evolution. Child clinicians, more than ever, will need a sound foundation of CBT theory and training so that they may fluidly practice and apply core principles in any setting, with any intervention. Transformations to the health care arena brought about by the ACA will see doctoral level clinicians practicing in a wider variety of roles, in highly integrated settings, and with an increasingly diverse population. Ability to ground intervention in solid theoretical framework will enable clinicians to practice in these numerous conditions effectively and meet accountability standards set by the ACA. Arming child clinicians with these skills will create a generation of practitioners well-prepared to care for youth in the developing atmosphere of mental health care in the United States.     

The cost‐effectiveness of family therapy: a summary and progress report

This paper provides a summary of the cost‐effectiveness research for family therapy. Data were available from four different sources in the United States: (1) a health maintenance organization with 180,000 subscribers; (2) the Medicaid system of the State of Kansas; (3) CIGNA Behavioral Health, a division of a health insurance company with nine million subscribers; and (4) a family therapy training clinic. Results suggest that family therapy reduces the number of healthcare visits, especially for high utilizers. The studies suggest that including family therapy as a treatment option does not significantly increase healthcare costs.     

Social Norms and Engagement in Protective Health Behaviors Among Rural Health Providers

Journal of Clinical Psychology in Medical Settings - The COVID-19 pandemic has had far-reaching effects for individuals and healthcare systems in the United States. Increasing and sustaining...     

Public Option Versus the Market: Perceived Value Violations Drive Opposition to Healthcare Reform

The debate over healthcare reform in the United States has been divisive. Research demonstrates that beliefs that policy beneficiaries violate values strongly predict opposition to these policies. Similar dynamics may be happening regarding opposition to healthcare reform. Specifically, this study tested the hypothesis that opposition to a public option in healthcare reform results from stereotypes that public‐option beneficiaries violate values. In two studies utilizing three samples, beliefs about beneficiaries violating values of hard work consistently predicted opposition to a public option and an alternative market‐based healthcare reform plan, often proposed by public‐option opponents. Results also suggest that assertions that a public option would lead to bigger government increases opposition to a public option by indirectly masking underlying stereotypes about value violations.     

On the impermissibility of euthanasia in Catholic healthcare organizations.

Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.     

Who Pays for Providing Spiritual Care in Healthcare Settings? The Ethical Dilemma of Taxpayers Funding Holistic Healthcare and the First Amendment Requirement for Separation of Church and State

All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.     

Policy and Financing of the Professional Psychology Workforce

The federal government has played a significant role in the financing the education of healthcare professionals since the introduction of Medicare in 1965. However, professional psychology's limited ability to argue the critical nature of its services to the welfare of the nation, and its lack of national workforce information and policy, has hindered its inclusion in Medicare's Graduate Medical Education (GME) program. This paper discusses the evolution and current status of healthcare workforce policy in the United States, and the implications for psychology and the training of future professionals. Also described are recent efforts by the American Psychological Association (APA) and a few psychologists to include professional psychology in the GME program. The importance of organized psychology's sustained involvement in national health policy is emphasized.     

Jewish Ethical Themes That Should Inform the National Healthcare Discussion: A Prolegomenon

Despite the passage of H.R. 3590 in the 111th Congress, the national healthcare debate in the United States continues, with repeal or modification of the Patient Protection and Affordable Care Act under ongoing consideration. Reference is often made to morality or ethics, but typically in general terms only. This paper elucidates themes from one system of moral theology, namely Jewish healthcare ethics, that would valuably inform this debate. Themes include "covenant," "holiness," "justice," "mercy," "for the sake of peace," "to save a life," "peoplehood," "repair of the world," "repentance," and "jubilee." Policy-related, economic, political, and moral challenges to acting on these principles are discussed.     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.     

Psychosocial Correlates of Medical Mistrust Among African American Men

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient–physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men’s mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient–physician interactions in ways that impede trust building processes.     

Patient–Provider Communication About Sexual Health: The Relationship with Gender, Age, Gender-Stereotypical Beliefs, and Perceptions of Communication Inappropriateness

This investigation examined patient–provider communication about sexual health related to gender and age. Data were collected from 277 individuals, aged 18–60, via convenience and snowball sampling at a large university in southwestern United States. Results indicate women are more proactive about their sexual health than men and tested for STDs more frequently. Women, more than men, initiate discussions with their healthcare provider about sexual health matters and healthcare providers are more likely to initiate communication about such matters with women than men. Men hold stronger gender-stereotypical beliefs than women, are less likely to initiate conversations about sexual issues with their provider, and believe sexual discussions with their partner are inappropriate. Age relates to sexual activity initiation and perceived STD risk.     

Identity as a Determinant of the Overreporting of Church Attendance in Canada

Recent work has demonstrated that Canadians overreport church attendance at rates similar to respondents in the United States. Overreporting in the United States has been attributed to the importance of religious identity; causes of Canadian overreporting have not been examined. This article draws upon Stryker's identity theory to explain why Canadian survey respondents overreport church attendance. The 2005 Canadian General Social Survey contains observed measures of attendance from both a conventional survey question and a time diary, allowing a direct and rigorous test of the identity explanation. Findings suggest that rates of Canadian overreporting, at about 50 percent, rival rates of overreporting in the United States. Moreover, like overreporting in the United States, Canadian overreporting may be affected by an identity process during the survey interview. Finally, implications for measuring religiosity in both countries are discussed.     

Ziprasidone as an augmenting agent in the treatment of anxiety-spectrum disorders

Anxiety disorders are currently one of the most common health concerns in the United States. Overall, they are the single largest cost to the healthcare system. They are also underdiagnosed and undertreated. Selective serotonin reuptake inhibitors and benzodiazepines appear to be the most common pharmacologic treatment approaches. Unfortunately, not all patients respond to these treatments. Many augmentation strategies have been tried in the past with varying levels of success or safety. This article describes a safe and highly effective augmentation technique in patients suffering from some of the most serious and debilitating forms of anxiety disorders, namely obsessive-compulsive disorder and panic disorder.     

Prevalence of suicide attempts in a Mexican-American population: prevention implications of immigration and cultural issues

Self-reported suicide ideation and suicide attempts were examined among 2,393 Mexican-Americans (706 born in Mexico, 538 born in the United States) and non-Hispanic whites (1,149 born in the United States). Mexican-Americans born in Mexico reported significantly lower age- and gender-adjusted lifetime rates of suicide thoughts (4.5%, 2.7-6.3%) than Mexican-Americans born in the United States (13.0%, 10.0-15.9%), who reported significantly lower rates than non-Hispanic whites born in the United States (19.2%, 17.4-21.0%). Adjusted rates of suicide attempt were lowest among Mexican-Americans born in Mexico (1.6%, 0.6-2.6%) and higher among both Mexican-Americans (4.8%, 2.4-7.2%) and non-Hispanic whites (4.4%, 3.4-5.4%) born in the United States. Rates were not affected by degree of acculturation when immigration status was controlled. High schools and the Catholic church are suggested as sites for programs designed to prevent suicide and suicide attempts among Mexican-Americans.     

African-American Teenagers’ Stories of Attention Deficit/Hyperactivity Disorder

Cultural differences in illness perceptions and treatment access of teens with attention deficit/hyperactivity disorder (ADHD) are evident yet under studied. The purpose of this qualitative paper is to explore how African-American teenagers describe and narrate stories about their lives with ADHD. Data were gathered from four African-American teens in the Southern United States through a qualitative experience sampling method, and stories were analyzed using narrative analysis framed within the context of African-American rhetorical traditions. We argue that the study of teen-constructed narratives and culturally-situated talk are tools that can improve communication between healthcare providers and teens by illuminating the ways teens construct their personalized realities of ADHD.     

A Secondary Analysis of Perceptions of Quality of Life of Older Adults Residing in a Nursing Home and Assisted Living Setting Using an Integrated Conceptual Model of Measurement

Quality of life is difficult to measure but is fast becoming the standard for long-term care. A secondary analysis was conducted of quality-of-life perceptions of older adults residing in a nursing home and then an assisted living facility from the perspectives of older adults and their family members/friends. This study shows that using a comprehensive integrated model that incorporates six major life domains of physical well-being, social well-being, psychological well-being, cognitive well-being, spiritual well-being, and environmental well-being into the assessment process appears to be a promising approach to determining quality-of-life perceptions of older adults. Findings also suggest that healthcare and human services professionals should place more reliance on indicators of social and environmental well-being, including opportunities for choice, when striving to maximize quality of life of older adults. As the demographic composition of the United States changes, policies and services will need to be modified to accommodate the changing needs of older adults in a way that optimizes perspectives of quality of life.     

COVID-19 Interconnectedness: Health Inequity,the Climate Crisis,and Collective Trauma

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.     

Individual and Social Factors in the Development of Graphic Symbolization

College student attitudes toward United States involvement in three international conflict areas were measured at various times during the years 1965 through 1971. An examination of the mean attitude scores obtained toward United States involvement in the Arab-Israel, India-Pakistan, and Vietnam conflicts revealed some reluctance on the part of the students to have the United States involved in any of these areas of international conflict.

Younger students were most dovish concerning United States involvement in Vietnam and were less so on the issues of the India-Pakistan and the Arab-Israel conflicts, whereas older students were more dovish regarding the issues of United States involvement in the Arab-Israel and India-Pakistan conflicts and least dovish with respect to the Vietnam conflict. Attitudes toward the involvement of the United States in both the Vietnam and Arab-Israel conflicts became significantly more dovish over time.     

Educating Genetic Counselors in Australia: Developing an International Perspective

The demand for genetic counseling services is increasing worldwide. This paper highlights the Australian experience of genetic counselor education and the history of the profession. The relevance of local factors, including the healthcare system, the education system and the small population in the evolution of the 1-year training programs are considered as an alternative model for emerging programs. The development of the education and training processes compared to that of other countries namely the United States of America (USA), the United Kingdom (UK) and Canada is discussed. The importance of international collaborations between the programs, to facilitate academic discussion and possible curriculum innovations, and to maintain professional understanding between genetic counselors is emphasized. Core genetic counseling competencies have been published for the UK and USA and an Australian set is proposed. In conclusion future directions are considered, including international issues around genetic counseling certification, reciprocity, and the potential for an Australian role in training genetic counselors in South East Asia.